PBMs of UnitedHealth, Anthem Attract Spotlight in 2Q Earnings

July 25, 2019

Two managed care organizations with their own PBMs, one established and one just getting underway, put those entities in the spotlight during recent earnings calls. UnitedHealth Group led off MCOs’ reporting of second-quarter 2019 financial results with solid earnings once again driven by its subsidiary Optum — and OptumRx’s performance, including its strong selling season, figured heavily in management’s commentary during the July 18 earnings call. Six days later, Anthem, Inc. highlighted the accelerated launch of its PBM IngenioRx and announced its first external pharmacy win. Both companies raised their full-year outlooks based partly on PBM results.

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Two managed care organizations with their own PBMs, one established and one just getting underway, put those entities in the spotlight during recent earnings calls. UnitedHealth Group led off MCOs’ reporting of second-quarter 2019 financial results with solid earnings once again driven by its subsidiary Optum — and OptumRx’s performance, including its strong selling season, figured heavily in management’s commentary during the July 18 earnings call. Six days later, Anthem, Inc. highlighted the accelerated launch of its PBM IngenioRx and announced its first external pharmacy win. Both companies raised their full-year outlooks based partly on PBM results.

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Will Blockchain Transform Relationships Industry Wide?

July 25, 2019

No one seems to dispute the market potential of blockchain, and, according to recent reports, IBM Corp. has tripled the number of its U.S. patents for the technology to exceed 100 in the past year. Several months ago, experts told AIS Health that blockchain was not so much “emerging” as gaining momentum, with the health care industry acting as a fast follower rather than an early adopter on using blockchain for such purposes as provider directories and credentialing. And efforts had gotten underway via three major health-care blockchain collaborations announced since November, one being led by IBM.

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No one seems to dispute the market potential of blockchain, and, according to recent reports, IBM Corp. has tripled the number of its U.S. patents for the technology to exceed 100 in the past year. Several months ago, experts told AIS Health that blockchain was not so much “emerging” as gaining momentum, with the health care industry acting as a fast follower rather than an early adopter on using blockchain for such purposes as provider directories and credentialing. And efforts had gotten underway via three major health-care blockchain collaborations announced since November, one being led by IBM.

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Biosimilars Have Barely Scratched Surface of Their Savings Potential

July 25, 2019

Though the current biosimilar market in the U.S. is creating $253.8 million annually in savings, considerably more savings could be realized if these medicines had a greater share of the market, according to a new issue brief from the Pacific Research Institute, a right-leaning think tank.

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Though the current biosimilar market in the U.S. is creating $253.8 million annually in savings, considerably more savings could be realized if these medicines had a greater share of the market, according to a new issue brief from the Pacific Research Institute, a right-leaning think tank.

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More Than 1M Medicare Part D Enrollees Had High Out-of-Pocket Drug Spending in 2017

July 25, 2019

by Jinghong ChenAbout 1 million Medicare Part D beneficiaries without low-income subsidies (LIS) had out-of-pocket prescription drug spending above the catastrophic threshold in 2017, with the average annual OOP cost reaching $3,214, according to a recent Kaiser Family Foundation analysis. As Part D does not place a hard cap on OOP spending, enrollees are required to pay up to 5% of their total drug costs for spending above the catastrophic threshold, unless they receive LIS. Over the past decade, the share of OOP spending in the catastrophic coverage phase has increased among Part D enrollees with high OOP drug costs, from 13% in 2007 to 44% in 2017. The Affordable Care Act’s changes to Part D benefit design, which included a manufacturer discount on brand-name drugs while in the coverage gap, contributed to that growth.

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by Jinghong ChenAbout 1 million Medicare Part D beneficiaries without low-income subsidies (LIS) had out-of-pocket prescription drug spending above the catastrophic threshold in 2017, with the average annual OOP cost reaching $3,214, according to a recent Kaiser Family Foundation analysis. As Part D does not place a hard cap on OOP spending, enrollees are required to pay up to 5% of their total drug costs for spending above the catastrophic threshold, unless they receive LIS. Over the past decade, the share of OOP spending in the catastrophic coverage phase has increased among Part D enrollees with high OOP drug costs, from 13% in 2007 to 44% in 2017. The Affordable Care Act’s changes to Part D benefit design, which included a manufacturer discount on brand-name drugs while in the coverage gap, contributed to that growth.

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News Briefs

July 25, 2019

✦ On July 18, Ohio’s Republican Gov. Mike DeWine “vetoed a plan to dump Ohio’s current Medicaid pharmacy benefit managers, saying the legislative budget provision restricts his Medicaid department too much,” The Columbus Dispatch reported. It was among 25 vetoes that DeWine issued to the state’s two-year operating budget, the news outlet said. DeWine said the Ohio Dept. of Medicaid “is willing to proceed with the provisions that achieve the legislature’s goal of a single Medicaid pharmacy benefit manager, but the department requires flexibility to implement this goal successfully.” Read the Dispatch story at https://bit.ly/2y2tAw7.

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✦ On July 18, Ohio’s Republican Gov. Mike DeWine “vetoed a plan to dump Ohio’s current Medicaid pharmacy benefit managers, saying the legislative budget provision restricts his Medicaid department too much,” The Columbus Dispatch reported. It was among 25 vetoes that DeWine issued to the state’s two-year operating budget, the news outlet said. DeWine said the Ohio Dept. of Medicaid “is willing to proceed with the provisions that achieve the legislature’s goal of a single Medicaid pharmacy benefit manager, but the department requires flexibility to implement this goal successfully.” Read the Dispatch story at https://bit.ly/2y2tAw7.

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NCQA to Plans: Expect ‘Messy Period’ as HEDIS Modernizes

July 22, 2019

The National Committee for Quality Assurance (NCQA) continues seeking feedback from the industry on its impending overhaul of health plans’ quality performance measurement under the decades-old Healthcare Effectiveness Data and Information Set (HEDIS). As NCQA moves ahead on setting up a digital future for HEDIS, the organization stresses that it aims to collaborate with plans on a gradual process toward a faster, easier and more accurate way to collect data.

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The National Committee for Quality Assurance (NCQA) continues seeking feedback from the industry on its impending overhaul of health plans’ quality performance measurement under the decades-old Healthcare Effectiveness Data and Information Set (HEDIS). As NCQA moves ahead on setting up a digital future for HEDIS, the organization stresses that it aims to collaborate with plans on a gradual process toward a faster, easier and more accurate way to collect data.

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